Gomez Fernando, Curcio Carmen Lucia, Brennan-Olsen Sharon Lee, Boersma Derek, Phu Steven, Vogrin Sara, Suriyaarachchi Pushpa, Duque Gustavo
Research Group on Geriatrics and Gerontology, Faculty of Health Sciences, Universidad de Caldas, Manizales, Colombia.
Medicine-Western Health, Melbourne Medical School, The University of Melbourne, St Albans, Victoria, Australia.
BMJ Open. 2019 Jul 29;9(7):e027013. doi: 10.1136/bmjopen-2018-027013.
Traditionally, the approach to fracture prevention has focused on increasing bone mineral density while typically lacking a combined clinical approach to falls prevention and vice versa. To resolve this gap, we implemented and evaluated a novel combined model of care to the assessment and prevention of osteoporosis and falls in the outpatients setting.
Falls and Fractures Clinic (FFC) at Nepean Hospital (Penrith, NSW, Australia).
Pre-effects and posteffects assessment of 106 community-dwelling older patients referred from the community.
Previous falls and fractures were recorded. Clinical, functional and paraclinical evaluations were performed. A comprehensive multidisciplinary care plan was then tailored based on the presence of risk factors. Six-month follow-ups were performed assessing the incidence of falls and fractures, change in risk factors for falls and level of risk, with the recommended plan.
We report that 97% of patients had a fall in the preceding 6 months, 47.6% of whom experienced a fracture from the fall. Furthermore, 64% of patients had a marked risk for falling by Physiological Profile Assessment (PPA), 90% had intermediate-high 10-year probability of fracture according to FRAX and 78% had sarcopenia. At 6-month follow-up, we observed more than an 80% reduction in falls and recurrent falls, and 50% reduction in fractures. In addition, 65% of patients had reduced PPA and a 57% reduction in 10-year fracture probability.
In conclusion, we suggest that a multidisciplinary FFC can provide substantial reductions in falls and fractures for high-risk older people, even over a relatively short 6-month time period. The current model of service provision via traditional falls clinics could be significantly improved by encompassing fracture prevention within the multifactorial approach to interventions.
传统上，骨折预防方法主要侧重于增加骨密度，而通常缺乏预防跌倒的综合临床方法，反之亦然。为了弥补这一差距，我们实施并评估了一种新型综合护理模式，用于门诊骨质疏松症和跌倒的评估与预防。
澳大利亚新南威尔士州彭里斯市尼平医院的跌倒与骨折诊所（FFC）。
对106名从社区转诊的居家老年患者进行干预前和干预后评估。
记录既往跌倒和骨折情况。进行临床、功能和辅助检查评估。然后根据危险因素制定全面的多学科护理计划。进行为期6个月的随访，评估跌倒和骨折的发生率、跌倒危险因素的变化以及风险水平，并按照推荐计划进行。
我们报告称，97%的患者在过去6个月内发生过跌倒，其中47.6%的患者因跌倒导致骨折。此外，根据生理特征评估（PPA），64%的患者有明显的跌倒风险，根据FRAX评估，90%的患者有中高程度的10年骨折概率，78%的患者有肌肉减少症。在6个月的随访中，我们观察到跌倒和再次跌倒减少了80%以上，骨折减少了50%。此外，65%的患者PPA降低，10年骨折概率降低了57%。
总之，我们建议多学科的FFC即使在相对较短的6个月时间内，也能显著降低高危老年人的跌倒和骨折发生率。通过在多因素干预方法中纳入骨折预防，目前通过传统跌倒诊所提供服务的模式可以得到显著改善。
